- Email: [email protected]
208 SAFETY OF INTRAOPERATIVE HEMODIALYSIS DURING LIVER TRANSPLANTATION: A 10-YEAR EXPERIENCE
POSTERS 206 THE UN-SUSTAINABLE MATCH IN HCV LIVER TRANSPLANT PATIENTS A.W. Avolio1 , S. Agnes1 , M.C. Lirosi1 , M. Salizzoni2 , A. Pinna3 , B. Gridelli4 , L. De Carlis5 , M. Colledan6 , G. Gerunda7 , U. Valente8 , G. Rossi9 , G. Ettorre10 , A. Risaliti11 , V. Mazzaferro12 , F. Bresadola13 , M. Rossi14 , G. Tisone15 , F. Zamboni16 , L. Lupo17 , O. Cuomo18 , F. Calise19 , A. Vitale20 , N. Nicolotti21 , R. Romagnoli2 , A. Cucchetti3 , S. Gruttadauria4 , I. Mangoni5 , D. Pinelli6 , R. Montalti7 , M. Gelli8 , L. Caccamo9 , G. Vennarecci10 , D. Nicolini11 , E. Regalia12 , U. Baccarani13 , Q. Lai14 , T. Manzia15 , E. Tondolo16 , M. Rendina13 , A. Perrella17 , E. Scuderi19 , B. Antonelli9 , C. de Waure21 , M. Angelico15 , P. Burra20 , A. Gasbarrini1 , U. Cillo20 , Donor-to-Recipient Italian Liver Transplant (DR2-ILTx) Study Group. 1 Liver Transplant Center, “A.Gemelli”Hospital, Catholic University, Rome, 2 Liver Transplant Center, “S. Giovanni Battista” Hospital, University of Turin, Turin, 3 Liver Transplant Center, “S. Orsola” Hospital, University of Bologna, Bologna, 4 Liver Transplant Center, IsMeTT-UPMC, Palermo, 5 Liver TransplantCenter, “Niguarda” Hospital, Milan, 6 Liver Transplant Center, “Ospedali Riuniti”, Bergamo, 7 Liver Transplant Center, University of Modena and Reggio Emilia, Modena, 8 Liver Transplant Center, “S. Martino” Hospital, University of Genoa, Genoa, 9 Liver Transpantation Center, IRCCS Foundation, “Maggiore” Hospital, Milan, 10 Liver Transplant Center, “San Camillo-Forlanini” Hospital, Rome, 11 Liver Transplant Center, “Umberto I” Hospital, Polytechnic University of Marche, Ancona, 12 Liver Transplant Center, National Cancer Institute, IRCCS Foundation, Milan, 13 Liver Transplant Center, University of Udine, Udine, 14 Liver Transplant Center, “Umberto I” Hospital, “La Sapienza” University, 15 Liver Transplant Center, “Tor Vergata” University Hospital, Rome, 16 Liver Transplant Center, “G. Brotzu” University Hospital, Cagliari, 17 Liver Transplant Center, Department of Emergency and Organ Transplant, University of Bari, Bari, 18 Liver Transplant Center, Laparoscopic Hepatobiliary Surgical Unit, “A. Cardarelli” University Hospital, 19 Liver Transplant Center, Hepatobiliary Surgical Unit, “A. Cardarelli” University Hospital, Naples, 20 Liver Transplant Center, Department of Surgical and Gastroenterological Sciences, University of Padua, Padova, 21 Epidemiology and Biostatistics Unit, Institute of Hygiene, Catholic University, Rome, Italy E-mail: [email protected] Introduction: Donor to Recipient (D2R) MATCH is a matter of debate in liver transplantation (LTx). D-MELD (Donor Age x biochemical MELD) has been identified as an effective formula to predict Patient Survival (PS) according to D2R-MATCH in United States and in Italy. To avoid resource wasting, LTx of pts with a 5 yrsPS <50% has been questioned. Methods: As a subanalysis of the Italian D-MELD study, data obtained from 2355 HCV pts were evaluated using a training (2/3) and a validation set (1/3). D-MELD cutoffs were investigated using Kaplan Meier analyses. A web-site was implemented with a survival calculator (www.D-MELD.com, password “D-MELD123”). Results: A cutoff able to predict the 5 yrsPS <50% was identified at the D-MELD = 1750 (UN-SUSTAINABLE Match CutOff). 5 yrsPS = 44.2%, 95% CI 0.32–0.50 (training set); 5 yrsPS = 43.7%, 95% CI 0.28–0.49 (validation set). Patient survival (CI) according to match Sustainable match Unsustainable match
1 yr PS
2 yrs PS
3 yrs PS
4 yrs PS
5 yrs PS
87 (85–89) 76 (69–83)
81 (78–84) 63 (55–71)
78 (75–81) 58 (51–65)
75 (71–78) 52 (43–61)
70 (67–74) 44 (32–50)
We failed to identify a cutoff in HBV, HCC, Cholestatic Diseases. Discussion: The UN-SUSTAINABLE match cutoff identifies a population with poor prognosis. The 5 yrsPS=50% should be read as the minimal sustainable survival rate considering the competition within the waiting list. Using the 5 yrsPS <50% cut-off could be misleading because not evidence based. However it identifies a S88
subgroup (equal to 7%) of HCV patients with a performance status below the currently defined minimal survival requirement. In case of donor to recipient high-risk match (D-MELD >1750) we suggest to change the allocation from an HCV to a non-HCV recipient, following the principle that the allocation of an organ with a highrisk should be shifted from a patient with a high-risk to another patients with a lower-risk, in order to balance the overall risk. However, elderly grafts can be safely transplanted in HCV patients if D-MELD is <1750. 207 PERIPORTAL SINUSOIDAL FIBROSIS IS AN EARLY MARKER OF PORTAL HYPERTENSION AND SIGNIFICANT FIBROSIS IN HEPATITIS C RECURRENCE AFTER LIVER TRANSPLANTATION Z. Marino ˜ 1 , L. Mensa1 , G. Crespo1 , S. Lens1 , R. Miquel2 , J.A. Carrion ´ 1, S. Perez ´ del Pulgar1 , J. Bosch1 , X. Forns1 , M. Navasa1 . 1 Liver Unit, Hospital Clinic, CIBERehd, IDIBAPS, 2 Pathology Unit, Hospital Clinic, CIBERehd, IDIBAPS, Barcelona, Spain E-mail: [email protected] Introduction: Chronic HCV infection in liver transplant (LT) patients leads to cirrhosis in 30% of individuals only 5 years after LT. The presence of significant fibrosis (F ≥2) or portal hypertension (HVPG ≥6 mmHg) one year after LT identifies patients with an accelerated course. Sinusoidal fibrosis (SF) is an early expression of the fibrogenic process in response to liver injury. Its role in predicting an accelerated course of hepatitis C after LT has never been assessed. Aim: Evaluate whether SF is a reliable and early marker to identify HCV-infected patients with an accelerated course of hepatitis C after LT. Methods: 75 HCV-infected liver transplant patients were included. All patients underwent an early liver biopsy (2–6 months after LT), as well as an HVPG measurement and/or liver biopsy one year after LT. Patients with other diagnoses (acute rejection, biliar complications, pharmacological injury) were not considered for analysis. Samples were stained with Sirius Red and periportal SF was graded as mild, moderate or severe using a semi-quantitative scoring system. Results were correlated with the development of severe hepatitis C recurrence one year after LT (F ≥2 and/or HVPG ≥6 mmHg). Results: SF was scored as mild in 50 samples (66%), moderate in 13 (17%) and severe in 10 (16%). One year after LT, the mean HVPG value in patients with moderate or severe SF was 10.1 mmHg (25th – 75th quartiles 6.4–12.6) compared to 5.7 mmHg (25th –75th quartiles 3–7.5) in those with mild SF (p < 0.01). Portal hypertension (HVPG ≥6 mmHg) and significant fibrosis (F ≥2) one year after LT were detected in 86% and 76% of patients, respectively, in whom early SF was scored as moderate/severe (n = 19). The main factors related to the development of early SF were donor age (p < 0.01), AST (p = 0.03), GGT (p < 0.01), bilirrubine (p < 0.01) and viral load (log10 ) (p = 0.02) 3 months after LT. Conclusions: Significant periportal SF in the acute phase of hepatitis C recurrence accurately identifies patients with an accelerated course of the disease after LT. Scoring SF may be useful to adopt therapeutic decisions in an early stage of hepatitis C recurrence. 208 SAFETY OF INTRAOPERATIVE HEMODIALYSIS DURING LIVER TRANSPLANTATION: A 10-YEAR EXPERIENCE L. Matsuoka, W. Ananthapanyasut, M. Boyajian, S. Kang, A. Sedra, Y.S. Genyk, M.K. Nadim. University of Southern California, Los Angeles, CA, USA E-mail: [email protected] Background: Liver transplantation (LT) in patients with renal dysfunction is frequently complicated by major fluid excess, metabolic acidosis, electrolyte and coagulation abnormalities
Journal of Hepatology 2012 vol. 56 | S71–S224
POSTERS increasing the risks of operation. Intraoperative renal replacement therapy (RRT) is frequently required to combat these additional problems including large volume resuscitation and allow the surgery to proceed successfully. Continuous renal replacement therapy (CRRT) is frequently used in patients who are hemodynamically intolerant of hemodialysis (HD) however it requires continuous anticoagulation, associated with slower solute and volume removal and is an expensive mode of therapy compared to HD. Aim: This is the first study examining the feasibility and safety of intraoperative hemodialysis (HD) during LT in a large patient cohort. Methods: Restrospective, single center study of 175 patients who received intraoperative HD from 2001–2011, 59 of whom received a combined liver-kidney transplantation. Results: Average age was 52.6 years. 131 (74.9%) patients were on RRT at the time of LT, 43.5% of whom were on CRRT, for a median of 11 days. For those patients not on RRT, the mean creatinine was 3.2 mg/dl. Median MELD was 38, 53% were in the ICU, 19% required mechanical ventilation and 50% of patients were on pressors at the time of LT. Mean intraoperative HD time was 442 minutes with lowest mean systolic pressure 81 mmHg during dialysis. Patients on average received 8L of colloids and crystalloids, 15 units of packed red blood cells and 12 units of fresh frozen plazma without any change in central venous pressure despite an average urine output of 479 cc. There was 1 (0.6%) intraoperative death and 2 (1.1%) deaths within the first 24 hours post LT. For patients who underwent LT alone, 58% patients required RRT within 72 hours of LT, for an average of 15 days. Dialysis dependency was 11% by 1 month and 3% by 3 months. Conclusion: This is the first study to demonstrate that intraoperative HD can be performed safely, efficiently and with hemodynamic tolerability in a cohort of critically ill patients undergoing liver transplantation with low long-term dialysis dependency. 209 SYSTEMATIC CT-SCAN ON POST-OPERATIVE DAY 7 AFTER LIVER TRANSPLANTATION DECREASES THE RATE OF RETRANSPLANTATION FOR ARTERIAL COMPLICATIONS R. Memeo1 , E. Vibert1,2,3 , O. Ciacio1 , R. Adam1,3 , J.-C. DuclosVallee1,2,3 , D. Samuel1,2,3 , D. Castaing1,2,3 . 1 Centre Hepato-Biliaire, AP-HP – Hˆ opital Paul Brousse, 2 Unit 785, INSERM, Villejuif, 3 Faculte de Medecine, Univ Paris-Sud, Le Kremlin-Bicˆetre, France E-mail: [email protected] Objective: Arterial thrombosis is a main cause of graft lost after liver transplant (LT). Objective of this study was to assess the incidence of systematic CT-scan on post-operative day (POD) 7 on the rate of retransplantation (ReLT). Materials and Methods: 232 consecutives patient transplanted in 1997–1999 (1st period) were compared to 250 transplanted in 2008–2010 (2nd period) in the same center. A clinical, biological and echodoppler control was daily performed from POD1 to POD7. An injected CT-Scan was realized only in case of abnormalities in 1st period and systematically on POD7 in 2nd period. Graft and donor features, risk factors of AT, incidence of arterial stenosis (AS) or thrombosis (AT), their treatments and their consequences in the 1st year after LT were compared in the two groups. Results: The 2 groups (1st vs 2nd period) were different for donors’ ages and body mass index (age: 41±1 years vs 52±1 years; p = 0.0001 – BMI: 23±4 vs 25±5; p = 0.0001) and recipients’ ages (46±1 years vs 50±1 years; p = 0.0004). In the 2nd period, the incidence of AS was significantly higher, 1/232 (0.4%) vs 11/250 (4%); p = 0.006, and the incidence of AT at 1 year was lower but not significantly, 11/232 (4.7%) vs 5/250 (2%); p = 0.2. Systematic POD7 injected CT-scan had significantly increased the radiological
diagnosis of AS and/or AT (1st vs 2nd period): 7/12 (58%) vs 15/16 (94%); p = 0.05 and decreased its diagnosis delay (3±2.5 months vs 1.1±0.3 months). In the 1st period, AS or AT treatments had been reLT (n = 5), arterial reconstruction (n = 3), stent (n = 1) or anticoagulation (n = 3). In the 2nd period, treatments had been reLT (n = 1), arterial reconstruction (n = 4), stent (n = 3) or anticoagulation (n = 8). After AS and/or AT, the rate of 1st year reLT was 5/12 (42%) in 1st period vs 1/16 (6%) in the 2nd period; p = 0.04 and 1st year mortality was 1/12(8%) vs 0/16(0%); p = 0.5. Conclusion: A systematic injected CT-scan on post-operative day 7 after LT decreased the rate of reLT for arterial thrombosis by improving early detection and treatment of arterial abnormalities. 210 THE CLINICAL IMPACT OF PREOPERATIVE ESTIMATION OF REMNANT LIVER FUNCTION USING 99MTC-LABELLED GALACTOSYL-HUMAN SERUM ALBUMIN LIVER SCINTIGRAPHY A. Miki, Y. Sakuma, N. Sata, Y. Yasuda. Surgery, Jichi Medical University, Shimotsuke-City, Japan E-mail: [email protected] Background and Aim: The estimation of liver function preserved before hepatectomy is important to perform operation safely. The aim of this study is to assess the clinical value of preoperative estimation of remnant liver function using 99mTclabelled galactosyl-human serum albumin liver scintigraphy and computed tomography. Methods: One hundred and forty eight patients who had hepatic resection including lobectomy or partial resection were studied. Liver function was estimated by both liver single photon emission computed tomography (SPECT) and computed tomography (CT) scans using 99mTc-labelled diethylene triamine penta acetate galactosyl human serum albumin (GSA). Preoperative remnant liver function was calculated by hepatic regional GSA clearance using SPECT with fusion image of CT scan. Liver failure was defined as acites, total bilirubin (more than 3 mg/dl), or encephalopathy. Results: Fifteen patients (10%) of 147 patients developed liver failure. All seven patients whose remnant liver function less than 75 ml/min developed liver failure after hepatectomy. Regression analysis of clearance of remnant liver correlated with postoperative max total bilirubin with log approximation (R = 0.76, P < 0.01). Areas under the ROC curves for GSA clearance of remnant liver, whole liver, and LHL15 were 0.92, 0.62, and 0.58 respectively. Conclusion: GSA clearance of remnant liver calculated using fusion images of SPECT and CT is useful in evaluating the risk of postoperative liver failure, which may contribute to the appropriate selection of operative procedure. 211 LIVER TRANSPLANTATION FOR OVERLAP SYNDROMES OF AUTOIMMUNE LIVER DISEASES R.A. Bhanji1 , A.L. Mason2 , A.J. Montano-Loza2 . 1 University of Alberta, 2 Gastroenterology & Liver Unit, University of Alberta, Edmonton, AB, Canada E-mail: [email protected] Background and Aims: The term overlap syndrome describes variant forms of autoimmune hepatitis (AIH) that present in combination with either characteristics of primary biliary cirrhosis (PBC), or primary sclerosing cholangitis (PSC). This study analyses the recurrence and other outcomes after liver transplantation in patients with overlap syndromes compared to patients transplanted for single autoimmune liver disease. Methods: We evaluated 231 adult patients who received a liver transplant due to autoimmune liver diseases; including 103 with PBC, 84 with PSC, 32 with AIH, and 12 with overlap syndrome (7 AIH-PBC, and 5 AIH-PSC). Results: The duration from diagnosis to liver transplantation was significantly shorter in patients with overlap syndromes
Journal of Hepatology 2012 vol. 56 | S71–S224
S89
1 yr PS
2 yrs PS
3 yrs PS
4 yrs PS
5 yrs PS
87 (85–89) 76 (69–83)
81 (78–84) 63 (55–71)
78 (75–81) 58 (51–65)
75 (71–78) 52 (43–61)
70 (67–74) 44 (32–50)
We failed to identify a cutoff in HBV, HCC, Cholestatic Diseases. Discussion: The UN-SUSTAINABLE match cutoff identifies a population with poor prognosis. The 5 yrsPS=50% should be read as the minimal sustainable survival rate considering the competition within the waiting list. Using the 5 yrsPS <50% cut-off could be misleading because not evidence based. However it identifies a S88
subgroup (equal to 7%) of HCV patients with a performance status below the currently defined minimal survival requirement. In case of donor to recipient high-risk match (D-MELD >1750) we suggest to change the allocation from an HCV to a non-HCV recipient, following the principle that the allocation of an organ with a highrisk should be shifted from a patient with a high-risk to another patients with a lower-risk, in order to balance the overall risk. However, elderly grafts can be safely transplanted in HCV patients if D-MELD is <1750. 207 PERIPORTAL SINUSOIDAL FIBROSIS IS AN EARLY MARKER OF PORTAL HYPERTENSION AND SIGNIFICANT FIBROSIS IN HEPATITIS C RECURRENCE AFTER LIVER TRANSPLANTATION Z. Marino ˜ 1 , L. Mensa1 , G. Crespo1 , S. Lens1 , R. Miquel2 , J.A. Carrion ´ 1, S. Perez ´ del Pulgar1 , J. Bosch1 , X. Forns1 , M. Navasa1 . 1 Liver Unit, Hospital Clinic, CIBERehd, IDIBAPS, 2 Pathology Unit, Hospital Clinic, CIBERehd, IDIBAPS, Barcelona, Spain E-mail: [email protected] Introduction: Chronic HCV infection in liver transplant (LT) patients leads to cirrhosis in 30% of individuals only 5 years after LT. The presence of significant fibrosis (F ≥2) or portal hypertension (HVPG ≥6 mmHg) one year after LT identifies patients with an accelerated course. Sinusoidal fibrosis (SF) is an early expression of the fibrogenic process in response to liver injury. Its role in predicting an accelerated course of hepatitis C after LT has never been assessed. Aim: Evaluate whether SF is a reliable and early marker to identify HCV-infected patients with an accelerated course of hepatitis C after LT. Methods: 75 HCV-infected liver transplant patients were included. All patients underwent an early liver biopsy (2–6 months after LT), as well as an HVPG measurement and/or liver biopsy one year after LT. Patients with other diagnoses (acute rejection, biliar complications, pharmacological injury) were not considered for analysis. Samples were stained with Sirius Red and periportal SF was graded as mild, moderate or severe using a semi-quantitative scoring system. Results were correlated with the development of severe hepatitis C recurrence one year after LT (F ≥2 and/or HVPG ≥6 mmHg). Results: SF was scored as mild in 50 samples (66%), moderate in 13 (17%) and severe in 10 (16%). One year after LT, the mean HVPG value in patients with moderate or severe SF was 10.1 mmHg (25th – 75th quartiles 6.4–12.6) compared to 5.7 mmHg (25th –75th quartiles 3–7.5) in those with mild SF (p < 0.01). Portal hypertension (HVPG ≥6 mmHg) and significant fibrosis (F ≥2) one year after LT were detected in 86% and 76% of patients, respectively, in whom early SF was scored as moderate/severe (n = 19). The main factors related to the development of early SF were donor age (p < 0.01), AST (p = 0.03), GGT (p < 0.01), bilirrubine (p < 0.01) and viral load (log10 ) (p = 0.02) 3 months after LT. Conclusions: Significant periportal SF in the acute phase of hepatitis C recurrence accurately identifies patients with an accelerated course of the disease after LT. Scoring SF may be useful to adopt therapeutic decisions in an early stage of hepatitis C recurrence. 208 SAFETY OF INTRAOPERATIVE HEMODIALYSIS DURING LIVER TRANSPLANTATION: A 10-YEAR EXPERIENCE L. Matsuoka, W. Ananthapanyasut, M. Boyajian, S. Kang, A. Sedra, Y.S. Genyk, M.K. Nadim. University of Southern California, Los Angeles, CA, USA E-mail: [email protected] Background: Liver transplantation (LT) in patients with renal dysfunction is frequently complicated by major fluid excess, metabolic acidosis, electrolyte and coagulation abnormalities
Journal of Hepatology 2012 vol. 56 | S71–S224
POSTERS increasing the risks of operation. Intraoperative renal replacement therapy (RRT) is frequently required to combat these additional problems including large volume resuscitation and allow the surgery to proceed successfully. Continuous renal replacement therapy (CRRT) is frequently used in patients who are hemodynamically intolerant of hemodialysis (HD) however it requires continuous anticoagulation, associated with slower solute and volume removal and is an expensive mode of therapy compared to HD. Aim: This is the first study examining the feasibility and safety of intraoperative hemodialysis (HD) during LT in a large patient cohort. Methods: Restrospective, single center study of 175 patients who received intraoperative HD from 2001–2011, 59 of whom received a combined liver-kidney transplantation. Results: Average age was 52.6 years. 131 (74.9%) patients were on RRT at the time of LT, 43.5% of whom were on CRRT, for a median of 11 days. For those patients not on RRT, the mean creatinine was 3.2 mg/dl. Median MELD was 38, 53% were in the ICU, 19% required mechanical ventilation and 50% of patients were on pressors at the time of LT. Mean intraoperative HD time was 442 minutes with lowest mean systolic pressure 81 mmHg during dialysis. Patients on average received 8L of colloids and crystalloids, 15 units of packed red blood cells and 12 units of fresh frozen plazma without any change in central venous pressure despite an average urine output of 479 cc. There was 1 (0.6%) intraoperative death and 2 (1.1%) deaths within the first 24 hours post LT. For patients who underwent LT alone, 58% patients required RRT within 72 hours of LT, for an average of 15 days. Dialysis dependency was 11% by 1 month and 3% by 3 months. Conclusion: This is the first study to demonstrate that intraoperative HD can be performed safely, efficiently and with hemodynamic tolerability in a cohort of critically ill patients undergoing liver transplantation with low long-term dialysis dependency. 209 SYSTEMATIC CT-SCAN ON POST-OPERATIVE DAY 7 AFTER LIVER TRANSPLANTATION DECREASES THE RATE OF RETRANSPLANTATION FOR ARTERIAL COMPLICATIONS R. Memeo1 , E. Vibert1,2,3 , O. Ciacio1 , R. Adam1,3 , J.-C. DuclosVallee1,2,3 , D. Samuel1,2,3 , D. Castaing1,2,3 . 1 Centre Hepato-Biliaire, AP-HP – Hˆ opital Paul Brousse, 2 Unit 785, INSERM, Villejuif, 3 Faculte de Medecine, Univ Paris-Sud, Le Kremlin-Bicˆetre, France E-mail: [email protected] Objective: Arterial thrombosis is a main cause of graft lost after liver transplant (LT). Objective of this study was to assess the incidence of systematic CT-scan on post-operative day (POD) 7 on the rate of retransplantation (ReLT). Materials and Methods: 232 consecutives patient transplanted in 1997–1999 (1st period) were compared to 250 transplanted in 2008–2010 (2nd period) in the same center. A clinical, biological and echodoppler control was daily performed from POD1 to POD7. An injected CT-Scan was realized only in case of abnormalities in 1st period and systematically on POD7 in 2nd period. Graft and donor features, risk factors of AT, incidence of arterial stenosis (AS) or thrombosis (AT), their treatments and their consequences in the 1st year after LT were compared in the two groups. Results: The 2 groups (1st vs 2nd period) were different for donors’ ages and body mass index (age: 41±1 years vs 52±1 years; p = 0.0001 – BMI: 23±4 vs 25±5; p = 0.0001) and recipients’ ages (46±1 years vs 50±1 years; p = 0.0004). In the 2nd period, the incidence of AS was significantly higher, 1/232 (0.4%) vs 11/250 (4%); p = 0.006, and the incidence of AT at 1 year was lower but not significantly, 11/232 (4.7%) vs 5/250 (2%); p = 0.2. Systematic POD7 injected CT-scan had significantly increased the radiological
diagnosis of AS and/or AT (1st vs 2nd period): 7/12 (58%) vs 15/16 (94%); p = 0.05 and decreased its diagnosis delay (3±2.5 months vs 1.1±0.3 months). In the 1st period, AS or AT treatments had been reLT (n = 5), arterial reconstruction (n = 3), stent (n = 1) or anticoagulation (n = 3). In the 2nd period, treatments had been reLT (n = 1), arterial reconstruction (n = 4), stent (n = 3) or anticoagulation (n = 8). After AS and/or AT, the rate of 1st year reLT was 5/12 (42%) in 1st period vs 1/16 (6%) in the 2nd period; p = 0.04 and 1st year mortality was 1/12(8%) vs 0/16(0%); p = 0.5. Conclusion: A systematic injected CT-scan on post-operative day 7 after LT decreased the rate of reLT for arterial thrombosis by improving early detection and treatment of arterial abnormalities. 210 THE CLINICAL IMPACT OF PREOPERATIVE ESTIMATION OF REMNANT LIVER FUNCTION USING 99MTC-LABELLED GALACTOSYL-HUMAN SERUM ALBUMIN LIVER SCINTIGRAPHY A. Miki, Y. Sakuma, N. Sata, Y. Yasuda. Surgery, Jichi Medical University, Shimotsuke-City, Japan E-mail: [email protected] Background and Aim: The estimation of liver function preserved before hepatectomy is important to perform operation safely. The aim of this study is to assess the clinical value of preoperative estimation of remnant liver function using 99mTclabelled galactosyl-human serum albumin liver scintigraphy and computed tomography. Methods: One hundred and forty eight patients who had hepatic resection including lobectomy or partial resection were studied. Liver function was estimated by both liver single photon emission computed tomography (SPECT) and computed tomography (CT) scans using 99mTc-labelled diethylene triamine penta acetate galactosyl human serum albumin (GSA). Preoperative remnant liver function was calculated by hepatic regional GSA clearance using SPECT with fusion image of CT scan. Liver failure was defined as acites, total bilirubin (more than 3 mg/dl), or encephalopathy. Results: Fifteen patients (10%) of 147 patients developed liver failure. All seven patients whose remnant liver function less than 75 ml/min developed liver failure after hepatectomy. Regression analysis of clearance of remnant liver correlated with postoperative max total bilirubin with log approximation (R = 0.76, P < 0.01). Areas under the ROC curves for GSA clearance of remnant liver, whole liver, and LHL15 were 0.92, 0.62, and 0.58 respectively. Conclusion: GSA clearance of remnant liver calculated using fusion images of SPECT and CT is useful in evaluating the risk of postoperative liver failure, which may contribute to the appropriate selection of operative procedure. 211 LIVER TRANSPLANTATION FOR OVERLAP SYNDROMES OF AUTOIMMUNE LIVER DISEASES R.A. Bhanji1 , A.L. Mason2 , A.J. Montano-Loza2 . 1 University of Alberta, 2 Gastroenterology & Liver Unit, University of Alberta, Edmonton, AB, Canada E-mail: [email protected] Background and Aims: The term overlap syndrome describes variant forms of autoimmune hepatitis (AIH) that present in combination with either characteristics of primary biliary cirrhosis (PBC), or primary sclerosing cholangitis (PSC). This study analyses the recurrence and other outcomes after liver transplantation in patients with overlap syndromes compared to patients transplanted for single autoimmune liver disease. Methods: We evaluated 231 adult patients who received a liver transplant due to autoimmune liver diseases; including 103 with PBC, 84 with PSC, 32 with AIH, and 12 with overlap syndrome (7 AIH-PBC, and 5 AIH-PSC). Results: The duration from diagnosis to liver transplantation was significantly shorter in patients with overlap syndromes
Journal of Hepatology 2012 vol. 56 | S71–S224
S89